Evaluation of sphincter-preserving surgery for rectal cancer

Abstract

Background: Rectal carcinoma constitutes a health problem, previously managed with abdomino-perineal resection (APR) which has the impact of poor patient quality of life. With the introduction of the concept of total mesorectal excision (TME) and stapler technology, sphincter saving surgery (SSS) with its better local control and functional status is a better choice than APR. We tried to evaluate the operative safety, long-term oncologic andfunctional outcomes of SSS in rectal carcinoma. Patients and methods: Between October 2008 and October 2012, patients with rectal carcinoma who presented electively to Sohag University Hospital underwent SSSbased on sharp mesorectal excision in the form of anterior resection, low anterior resection and intersphincteric resection were evaluated. Patients were followed up for four years. Results: A total of 60 patients underwent SSS, regarding operative complications; there were 2 ureteric injuries and one bladder injury. Postoperatively, anastomotic leakage occurred in 6.7% of cases. Local recurrence and distant metastases were detected in 8.3% 13.3% respectively. During follow-up, disease-free survival rate was 66.9%, overall survival rate was 93%, 22% of patients had a degree ofincontinence. 21.66% had temporary bladder dysfunction. Sexual dysfunction became evident in 30% of male patients. Conclusion: SSS with TME provides a better alternative to APR in rectal carcinoma when feasible.